During my training and beyond, I’ve confronted the phrase “coming to terms” dozens of times, in print and from mouths of supervisors, and patients too. Coming to terms represents a goal, likely a reasonable and important one, for patients in therapy.

But often I’ve wondered: What exactly does it mean “coming to terms”? How does a person, either a patient or clinician, know when it is achieved? And can it really ever be “achieved”? Or does one forever approach it in its elusiveness?

And when coming to terms is finally achieved or, at the least, has gotten close to, how does that new state change a person? Do they think differently? If so, how? Do they act differently? If so, how? Do their emotional responses differ? And if so, how? And, if coming to terms does result in one or more beneficial change, how does a person “come” to it? And how, as clinicians, can we guide patients towards that home-coming?

Today I wish to begin to explore the concept of coming to terms and its impact, in its presence and absence, on a person’s mental health. I ask that you join me in this quest, because everyone has something to add to this large, multifaceted concept.

A key synonym for coming to terms is acceptance. This connection perhaps points us in the right direction but does not release us from our quest to understand it. After all, now we have “acceptance” to contend with and need to interrogate it in the same way we would be “coming to terms.”

Two things are clear when acceptance is at issue: first, it implies difficulty – if acceptance was easy to achieve, we wouldn’t need to discuss it. And second, desire – if acceptance were not desired, we wouldn’t need to discuss it either.

The reason acceptance is difficult in the cases that interest us is because the traumatizing experience that a person had – and its consequences – continue to trigger painful memories, sensations, emotions, or thoughts. This category of experiences includes ones that resulted in pain, fear, despair, rage, regret, shame, guilt, humiliation, grief, sense of betrayal, and / or loss of one’s assumptive world. In one way or another, the experiences were traumatizing to the person and remain so.

Concretely, what could these experiences have been? Childhood or adult trauma, of course. Living with a life-shortening or terminal disease, of course. But, to some degree, all of our patients can struggle with acceptance. Imagine a person who spent 30 years of life in more or less stable euthymia who then suffers a major depressive episode. Even after their full remission, do they feel they have been made whole? Not necessarily. Their experience of themselves – their unquestioned expectations of who they are – and their experience of their world – as they had seen it for those first three decades – has forever changed. They have crossed to another understanding of themselves and the world, one that feels a lot less stable and certain. They now live in a world that is populated by abysses, although they may be invisible, that lurk around corners and are ready to pounce at any time. Or imagine someone who’s lived through a manic episode. They will now forever know what it’s like to lose their mind and that losing their mind is something that is never far away.

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Let me now approach coming to terms and acceptance from another angle: what’s it like not yet to have come to terms? What does this mean?

I think it means, one, the person continues to hang on to “what might have been.” That is, they continue to imagine how great life would have been if their traumatizing experience had not occurred. They continue to have, “If only …” thoughts. In effect, in their imaginations there exists a parallel self, a self who never faced the trauma – was not diagnosed with cancer, was not assaulted, or did not suffer a loss of mind. The person continues in some way to reject their current life and self, and long for that untraumatized carefree parallel self. Coming to terms means accepting that there is no other self that is living in some untraumatized parallel world. There is only the self that is you, a you that now will never be made whole, a self that is damaged, a self that is bereft of unquestioned assumptions of safety and certainty.

Two, coming to terms also includes finding a way, painful and unwanted though the path may be, to incorporate that traumatic experience into one’s life narrative. The trauma is now inextricably part of the person; it cannot be excised, forgotten, or rejected. The trauma changed YOU and YOU are the only you that you have. Therefore, the traumatizing experience made you and its story must be told.

I think it is ok to tell patients that they will never be same – of course, this must be done with caution and at the right time. But deep down traumatized people know they will never be the same. They don’t want me, their shrink, to pretend otherwise because then they would be even more alone. I sometimes tell a patient, “You will never see the world the same again. You will look out at the world with perhaps sadder eyes, but you will understand more than most others do.” I’ve also told people, “Yes, you have been hurt, and some of the damage done will never heal. But you – just as I and all of us, damaged though we all are in our own way – can still do great things.”

I think that I have answered one of my initial questions: can one ever achieve a coming to terms? For many, the answer is there is never a completed acceptance that can be checked off one’s life’s list and put away. Acceptance may mean a daily awareness of the experiences that made one the person that one has become, and a daily dose of compassion towards oneself.

Until next time,

Dr. Jack


Today’s Quotes

“The first step to the knowledge of the wonder and mystery of life is the recognition of the monstrous nature of the earthly human realm as well as its glory, the realization that this is just how it is and that it cannot and will not be changed. Those who think they know how the universe could have been had they created it, without pain, without sorrow, without time, without death, are unfit for illumination.”
– Joseph Campbell

“For after all, the best thing one can do when it is raining is let it rain.”
– Henry Wadsworth Longfellow